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    Obstruction Sleep Apnoea in Children

    Introduction
    Causes
    Risk Factors
    What to Look Out For
    Complications
    Diagnosis
    Treatment
    Where to Seek Treatment
    KK Women's and Children's Hospital
    Contributed by Respiratory Medicine Services

    Introduction

    Obstruction sleep apnoea is a condition where there is recurrent ‘blockage’ of the upper airway during sleep, leading to reduced airflow to the lungs and sleep disruption. Snoring is an important symptom of obstructive sleep apnoea, but not all children with snoring will have obstructive sleep apnoea. Children with habitual snoring but no evidence of compromised breathing and sleep disruption have ‘primary snoring’.

    How common is it?
    It is estimated that overall, 3 to 12 percent of children have habitual snoring, and 1 to 3 percent of children have snoring with obstructive sleep apnoea. Boys and girls are equally affected. The peak age is between 4 to 7 years of age, usually in children with enlarged tonsils and/or adenoids. There is a second peak seen in older children above 8 years old who tend to be obese.

    Causes

    The two most important causes of obstructive sleep apnoea in children are enlarged tonsils and/or adenoids, and obesity.

    Risk Factors

    Other children at risk for obstructive sleep apnoea include children with neuromuscular (central nervous system and muscle) disorders, abnormalities in the jaw and/or face, Trisomy 21 (Down syndrome), and those with a family history of sleep and breathing disorders.

    What to Look Out For

    Some of the symptoms suggestive of obstructive sleep apnoea include:

    • Snoring
    • Apnoea (pauses in breathing during sleep)
    • Snorting, gasping noises during sleep
    • Laboured breathing during sleep, with ‘sucking in’ of the chest
    • Unusual sleeping positions, such as hyperextending the neck to breathe better, sitting up, or propped up with many pillows
    • Restlessness and frequent awakenings during sleep
    • Sweating during sleep
    • Mouth breathing in the day or during sleep
    • Cyanosis (blue discolouration of the lips/face)
    • Difficulty waking in the morning
    • Feeling unrefreshed after an overnight sleep
    • Morning headaches
    • Irritability or aggressive behaviour during the day
    • Learning difficulty
    • Excessive sleepiness during the day

    Complications

    Some of the complications of untreated significant obstructive sleep apnoea include:

    • Learning and/or behavioural problems
    • Poor growth
    • Diabetes, obesity, hypertension, heart failure, stroke
    • Death (in very severe, untreated cases – rare)

    Diagnosis

    Clinical history and physical examination are not sufficiently reliable to differentiate primary snoring from obstructive sleep apnoea. If the doctor suspects that your child has obstructive sleep apnoea, he will refer your child to a paediatric sleep specialist for review, and for an overnight polysomnography (sleep study).

    Your child will be admitted overnight to a single room in a sleep laboratory, where his/her sleep and breathing will be monitored and recorded continuously during sleep. There will be sensors placed on your child’s head and body, and elastic bands placed around his/her chest and abdomen, connected by wires to a computer system that records the data. This is not a painful procedure and most children will be able to fall asleep after they get used to the setup. A caregiver is allowed to stay overnight with the child during the study.

    Treatment

    The treatment of obstructive sleep apnoea in children depends on the underlying cause.

    In children with enlarged tonsils and/or adenoids, surgery would be recommended.

    For more information, please refer to our booklet: ‘Up Close: Get the answers to common Ear, Nose and Throat Conditions’ for more details on surgical treatment, including adenotonsillectomy (section: Common ENT conditions among Children – Snoring in Children and Tonsils & Adenoids).

    In children who are obese, weight loss measures such as healthy eating and regular exercise are encouraged. They may also be referred to paediatric specialists for weight management programmes and to screen for conditions such as diabetes, hypertension and hyperlipidaemia.

    In some children where surgery is not an option or if they continue to have significant residual obstructive sleep apnoea after surgery, they may be recommended the use of Continuous Positive Airway Pressure (CPAP) during sleep.

    The CPAP set-up consists of a face mask connected by a tubing to a machine that generates and delivers a positive pressure. This pressure helps to keep the upper airway of your child open during sleep. Children who are treated with CPAP will need to be managed by a paediatric sleep specialist, who will recommend regular follow-up checks and sleep studies.

    Besides the treatments mentioned above, a small group of children may benefit from an orthodontic assessment and other procedures or surgeries for their sleep apnoea.

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